What is the Medication Therapy Management Program?
Medication Therapy Management (MTM) is a Medicare-designed program that promotes collaboration between you, your pharmacist, and your prescribing doctor to ensure safe and effective medication use. It aims to improve health outcomes by focusing on safety, effectiveness, lower-cost alternatives, and adherence. This service is provided at no additional cost to qualified members and is not considered a Medicare Part D benefit.
Most of our members take multiple medications, and these may be prescribed by more than one healthcare professional. Some of those medications, when combined, may:
- Reduce the effectiveness of one or more of your medicines
- Cause side effects
- Cost you more money per month
As part of our MTM program, you may set up a one-on-one meeting with a pharmacist to go over your medications. This is called a Comprehensive Medication Review (CMR) and is offered at no cost to you. If the pharmacist who completes your CMR identifies a potential medication issue that needs attention, you may be contacted about a Targeted Medication Review (TMR).
Through the program, we want to help you get the best results from your medications. When you talk to a pharmacist, they can help you make sure your medications are working for you, find lower cost options (when possible) and answer questions or address concerns you may have about your medications.
How You Qualify for the Program
CarePlus determines monthly eligibility by looking at your medication claims information. To qualify for the MTM program, you must meet all three of the following criteria:
- Have at least three of the following conditions:
Bone Disease (Arthritis), Alzheimer's Disease, Chronic congestive heart failure (CHF), Diabetes, Dyslipidemia, End-stage renal disease (ESRD), Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS), Hypertension, Mental health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions), Respiratory Disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)
AND
- Take eight or more chronic maintenance (Part D) prescription drugs in a 90-day period
AND
- Likely to incur annual Part D medication costs of at least $1,623 for 2025 or $1,276 for 2026
OR
You qualified for the Drug Management Program because:
- You're in a drug management program to help better manage and safely use medications such as opioids and benzodiazepines
Once you qualify, you remain in the program for the rest of the calendar year. If you qualify for the program for the next calendar year, you will be automatically re-enrolled.
How We Notify You of Your MTM Eligibility
Once eligible, you will receive a letter that invites you to call Member Services to schedule your medication review. The review will last approximately 25 minutes, and we will schedule it at your convenience.
As part of your medication review, the pharmacist will:
- Go over the medicines you currently take
- Check to see if your medicines are safe for you
- Answer any questions you may have about your medicines
- Discuss lower-cost alternatives for your medicines
- Discuss your concerns about your medicines
- Work with you on ways to keep track of your medicines
You will receive a personal medication list and a summary of the medication review results (medication action plan). The medication list will help you keep track of the medications you take. The medication summary will offer you steps you can take to get the best results from your medications.
Below, we include a blank medication list you can print. Please use the form to keep track of all your prescriptions and over-the-counter medications.
